Ricardo Alonso-Zaldivar Associated Press
A
glitch in Medicare’s revamped
prescription plan finder can steer unwitting seniors to coverage that costs much more than
they need to pay, according to people who help with sign-ups as well as program
experts.
Serving
some 60 million Medicare recipients, the plan finder is the most commonly used
tool on Medicare.gov and just got its first major update in a decade. The Trump
administration has hailed the new version and Medicare Administrator Seema
Verma says it will empower beneficiaries to take advantage of their coverage
options.
But as
open enrollment goes into the home stretch Thanksgiving week, critics say the
new tool can create confusion by obscuring out-of-pocket costs that
seniors should factor into their decisions.
"I
want to make sure people are given the most accurate information and they’re
making the best decision – because they are the ones stuck with it,” said Ann
Kayrish, senior program manager for Medicare at the National Council on Aging,
a nonpartisan organization that advocates for seniors and provides community
services.
Government
programs mixing health care and technology have faced struggles. Despite
billions spent to subsidize electronic medical records, getting different
systems to communicate remains a challenge. The Obama administration’s launch
of HealthCare.gov resulted in an embarrassing debacle when the website froze up
the first day.
The
leading Democrat on the Senate Aging Committee said he’s hearing concerns from
constituents and organizations that assist Medicare beneficiaries. Pennsylvania
Sen. Bob Casey said he will ask Medicare to grant seniors who’ve had problems a
second chance to sign up, called a “special enrollment period.”
“It’s
obviously an effort that needs a lot more work to meet the legitimate
expectations of seniors,” said Casey. “Especially when you launch something
new, (it) can go awry. People steered in the wrong direction should get a
measure of fairness.”
The
Medicare plan finder’s issue stems from a significant change the agency made
for 2020.
The
plan with the lowest premium now gets automatically placed on top, with the
monthly premium displayed in large font.
Medicare’s
previous plan finder automatically sorted plans by total cost, not just
premiums.
But
premiums are only one piece of information.
When
out-of-pocket expenses such as copays are factored in, the plan with the lowest
total annual cost is often not the first one shown by the plan finder.
It
takes extra work for a Medicare enrollee to discover that.
“If
they pick the plan based solely on the premium they are likely getting a plan
that could cost them thousands more in a calendar year,” said Christina Reeg of
the Ohio Department of Insurance. She heads a program that helps Medicare
enrollees try to find the right plan.
In a
statement, Medicare said the monthly premium is a cost that consumers
understand and will always be an important decision factor. But the agency also
said total cost paid out-of-pocket is at least equally, if not more important,
particularly for people who take prescription drugs – as do most seniors.
Medicare
said it chose to prominently display premiums because user testing showed
that’s what consumers are familiar with. The total annual cost is
included but in smaller font.
That’s
puzzling to Kayrish. “The default sort right now is by lowest premium, but that
doesn’t necessarily translate to lowest cost over the year,” she explained.
Consumers
using the plan finder first enter their medications and dosages. To get it to
find plans by lowest total annual cost, they must take a few more steps, said
Kayrish.
After
the screen displays initial search results, consumers should look for the
drop-down menu on the right of the screen. Next, she said, select the feature
that lets you re-sort plans by “lowest drug + premium cost.”
A
reporter’s sample search on a list of six medications for high blood pressure,
high cholesterol and diabetes returned 29 plans in the Washington, D.C., area,
topped by a lowest-premium option for $13.20 a month.
But
after re-sorting for the lowest total cost, the best deal was a plan with a
monthly premium of $25.80.
When
out-of-pocket expenses were factored in, the second plan cost about $5,800 less
a year than the initial lowest-premium option the plan finder displayed.
Costs
can vary so much because plans have different coverage designs and they don’t
pay the same prices to drugmakers.
And
Kayrish said there’s another issue: The new plan finder can return options that
don’t cover all of a patient’s medications.
If a
low-premium plan has very high out-of-pocket costs, it’s a clue that some of
your drugs may not be covered. Check plan details.
Some
academic experts compared the old and new versions of the Medicare plan finder
and confirmed the problems flagged by hands-on users.
Their
review also found improvements. Among them:
— The new plan
finder automatically fills in all of a consumer’s medications that that
Medicare paid for, if the enrollee enters their Medicare number. (Consumer
advocates recommend double-checking this list.)
—
The new tool can be used more easily on mobile devices and tablets.
—
The revamped plan finder allows consumers to compare across Part D drug plans
and Medicare Advantage plans, which offer comprehensive medical coverage.
“The
new plan finder is in many ways improved, but it did take a meaningful step
backward by not doing more to highlight its most useful output – the total cost
estimate,” said Brian McGarry, an assistant professor at the University of
Rochester in New York. He’s the lead author of a recent online
article about the plan finder for Health Affairs.
Seniors
have until Dec. 7 to pick or switch “Part D” prescription drug plans or, if
they’re seeking comprehensive medical care through a private insurer, a
Medicare Advantage plan. Coverage takes effect Jan. 1.
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